月经周期对乳腺肿瘤患者术后麻醉苏醒质量的影响
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摘要
目的观察月经周期不同阶段对乳腺肿瘤患者术后麻醉苏醒质量的影响。方法选取2015年6月~2016年6月于首都医科大学附属北京友谊医院行手术治疗的女性乳腺癌患者168例,根据患者手术当天所处月经周期的阶段,将受试者分为卵泡期组55例,排卵期组53例和黄体期组60例,观察并比较三组的苏醒质量,包括苏醒时间、警觉/镇静评分(OAA/S)、复苏后麻醉恢复室(PACU)停留时间及术后麻醉不良反应发生率。结果黄体期组苏醒时间和PACU停留时间短于卵泡期组和排卵期组,拔管后5、15及30 min OAA/S评分高于卵泡期组和排卵期组,差异均有统计学意义(P<0.05或P<0.01);排卵期组苏醒时间和PACU停留时间短于卵泡期组,拔管后5 min和15 min OAA/S评分高于卵泡期组,差异有高度统计学意义(P<0.01)。三组术后恶心呕吐发生率比较,差异有高度统计学意义(P<0.01);黄体期组恶心呕吐的发生率低于卵泡期组和排卵期组,差异有高度统计学意义(P<0.01)。结论在黄体期进行乳腺肿瘤手术的患者麻醉质量优于排卵期和卵泡期的患者,术后恶心呕吐的发生率也显著降低。
Objective To observe the influence of menstrual cycle on recovery quality in breast cancer patients undergoing radical mastectomy. Methods The 168 patients with breast cancer undergoing radical mastectomy from June 2015 to June 2016 in Beijing Friendship Hospital, Capital Medical University were selected, and all cases were divided into follicular phase group(n = 55), ovulatory phase group(n = 53) and luteal phase group(n = 60) according to the different phases of menstrual cycle at the time of surgeries, and the recovery quality were observed and compared among three groups, including time of recovery, OAA/S score, time of stay in PACU and the incidence of postoperative anesthetic. Results The time of recovery and stay in PACU of the luteal phase group were shorter, and the modified observer′s assessment of alertness/sedation scale(OAA/S) score on 5, 15 and 30 min were higher in follicular phase group than those in the ovulatory phase group and luteal phase group, the differences were statistically significant(P < 0.05 or P < 0.01). The time of recovery and stay in PACU were lower, OAA/S score on 5 min and 15 min were higher in ovulatory phase group than those in the follicular phase group, the differences were statistically significant(P < 0.01).The incidence of postoperative nausea and vomiting was statistically significant among three groups(P < 0.01), and the incidence of postoperative nausea and vomiting in luteal phase group were lower than those in follicular phase group and ovulatory phase group, the differences were statistically significant(P < 0.01). Conclusion The patients undergoing breast cancer surgery during the luteal phase are better than those who are follicular phase and ovulatory phase, and the incidence of postoperative nausea and vomiting are also statistically reduced.
Objective To observe the influence of menstrual cycle on recovery quality in breast cancer patients undergoing radical mastectomy. Methods The 168 patients with breast cancer undergoing radical mastectomy from June 2015 to June 2016 in Beijing Friendship Hospital, Capital Medical University were selected, and all cases were divided into follicular phase group(n = 55), ovulatory phase group(n = 53) and luteal phase group(n = 60) according to the different phases of menstrual cycle at the time of surgeries, and the recovery quality were observed and compared among three groups, including time of recovery, OAA/S score, time of stay in PACU and the incidence of postoperative anesthetic. Results The time of recovery and stay in PACU of the luteal phase group were shorter, and the modified observer′s assessment of alertness/sedation scale(OAA/S) score on 5, 15 and 30 min were higher in follicular phase group than those in the ovulatory phase group and luteal phase group, the differences were statistically significant(P < 0.05 or P < 0.01). The time of recovery and stay in PACU were lower, OAA/S score on 5 min and 15 min were higher in ovulatory phase group than those in the follicular phase group, the differences were statistically significant(P < 0.01).The incidence of postoperative nausea and vomiting was statistically significant among three groups(P < 0.01), and the incidence of postoperative nausea and vomiting in luteal phase group were lower than those in follicular phase group and ovulatory phase group, the differences were statistically significant(P < 0.01). Conclusion The patients undergoing breast cancer surgery during the luteal phase are better than those who are follicular phase and ovulatory phase, and the incidence of postoperative nausea and vomiting are also statistically reduced.
引文
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[6]孟冬梅,张雪贞,温晓晖,等.性别对全麻苏醒期靶控输注丙泊酚的血药浓度和药效学的影响[J].中国临床药理学杂志,2017,33(5):411-414.
[7]侯丽红,吕克重.不同性别对腹部手术全身麻醉患者单次静脉注射丙泊酚的药代动力学影响研究[J].中国现代医学杂志,2015,25(24):89-92.
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[11]孙晓丽,刘雁峰,孙天琳,等.女性月经周期相关表现及影响因素的研究概况[J].中国医药导报,2013,10(18):33-35,38.
[12]张文丽,唐慧,张瑞,等.中枢神经系统中雌激素的研究进展[J].中国老年学杂志,2016,36(20):5184-5186.
[13]Li R,Cui J,Shen Y.Brain sex matters:Estrogen in cognition and Alzheimer's disease[J].Mol Cell Endocrinol,2014,389(1/2):13-21.
[14]Tuscher JJ,Szinte JS,Starrett JR,et al.Inhibition of local estrogen synthesis in the hippocampus impairs hippocampal memory consolidation in ovariectomized female mice[J].Horm Behav,2016,83:60-67.
[15]Arevalo MA,Azcoitia I,Garciasegura LM.The neuroprotective actions of oestradiol and oestrogen receptors[J].Nat Rev Neurosci,2015,16(1):17-29.
[16]闫懿,敖锋,宋健.雌激素及雌激素受体信号转导途径的研究进展[J].山西医药杂志,2016,45(9):1032-1034.
[17]曹小飞,孙杰,丁正年.妊娠可以减弱芬太尼对呼吸的抑制[J].临床麻醉学杂志,2012,26(6):528-530.
[18]Buchanan FF,Myles PS,Leslie K,et al.Gender and recovery after general anesthesia combined with neuromuscular blocking drugs[J].Anesth Analg,2006,102(1):291-297.
[19]傅峰.不同月经周期女性激素水平对异丙酚镇静作用的影响[D].杭州:浙江大学,2011.
[20]Gan TJ,Diemunsch P,Habib AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.
[21]陈醒,白文佩.5-羟色胺受体与潮热关系的研究进展[J].中华妇产科杂志,2014,49(5):395-397.
[22]马潇潇,张建洁,陈雪,等.月经周期及年龄对血清人附睾分泌蛋白4和CA125水平的影响[J].临床和实验医学杂志,2016,15(12):1211-1213.
[23]邱国美,何尧,丁洁岚,等.月经周期不同阶段对妇科腹腔镜手术后恶心及呕吐的影响[J].中国乡村医药,2014,21(4):14-15.
[2]Jia MM,Zheng R,Zhang S,et al.Female breast cancer incidence and mortality in 2011,China[J].J Thorac Dis,2015,7(7):1221-1226.
[3]陈万青,郑荣寿.中国女性乳腺癌发病死亡和生存状况[J].中国肿瘤临床,2015,42(13):668-674.
[4]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[5]万兰兰,张大奇,潘振祥,等.舒芬太尼与瑞芬太尼在甲状腺全麻手术苏醒质量中的对比[J].中国老年学杂志,2013,33(9):2036-2038.
[6]孟冬梅,张雪贞,温晓晖,等.性别对全麻苏醒期靶控输注丙泊酚的血药浓度和药效学的影响[J].中国临床药理学杂志,2017,33(5):411-414.
[7]侯丽红,吕克重.不同性别对腹部手术全身麻醉患者单次静脉注射丙泊酚的药代动力学影响研究[J].中国现代医学杂志,2015,25(24):89-92.
[8]张高,傅峰.月经周期对异丙酚麻醉半数有效剂量的影响及机制研究[J].中国现代医生,2015,53(22):12-15.
[9]Tatjana譒,Boris M,Neven S,et al.Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery:a pilotstudy[J].J Clin Anesth,2012,24(3):185-192.
[10]劳贤邦,庞德春,纪建波,等.两种苏醒评分方法对麻醉复苏效果影响的比较[J].护士进修杂志,2016,31(11):1043-1045.
[11]孙晓丽,刘雁峰,孙天琳,等.女性月经周期相关表现及影响因素的研究概况[J].中国医药导报,2013,10(18):33-35,38.
[12]张文丽,唐慧,张瑞,等.中枢神经系统中雌激素的研究进展[J].中国老年学杂志,2016,36(20):5184-5186.
[13]Li R,Cui J,Shen Y.Brain sex matters:Estrogen in cognition and Alzheimer's disease[J].Mol Cell Endocrinol,2014,389(1/2):13-21.
[14]Tuscher JJ,Szinte JS,Starrett JR,et al.Inhibition of local estrogen synthesis in the hippocampus impairs hippocampal memory consolidation in ovariectomized female mice[J].Horm Behav,2016,83:60-67.
[15]Arevalo MA,Azcoitia I,Garciasegura LM.The neuroprotective actions of oestradiol and oestrogen receptors[J].Nat Rev Neurosci,2015,16(1):17-29.
[16]闫懿,敖锋,宋健.雌激素及雌激素受体信号转导途径的研究进展[J].山西医药杂志,2016,45(9):1032-1034.
[17]曹小飞,孙杰,丁正年.妊娠可以减弱芬太尼对呼吸的抑制[J].临床麻醉学杂志,2012,26(6):528-530.
[18]Buchanan FF,Myles PS,Leslie K,et al.Gender and recovery after general anesthesia combined with neuromuscular blocking drugs[J].Anesth Analg,2006,102(1):291-297.
[19]傅峰.不同月经周期女性激素水平对异丙酚镇静作用的影响[D].杭州:浙江大学,2011.
[20]Gan TJ,Diemunsch P,Habib AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.
[21]陈醒,白文佩.5-羟色胺受体与潮热关系的研究进展[J].中华妇产科杂志,2014,49(5):395-397.
[22]马潇潇,张建洁,陈雪,等.月经周期及年龄对血清人附睾分泌蛋白4和CA125水平的影响[J].临床和实验医学杂志,2016,15(12):1211-1213.
[23]邱国美,何尧,丁洁岚,等.月经周期不同阶段对妇科腹腔镜手术后恶心及呕吐的影响[J].中国乡村医药,2014,21(4):14-15.